Reimbursement Accounts - Electronic Submission

Important Submission Information

HEALTHCARE CLAIMS

New Claims must be submitted with a fully completed and signed Reimbursement Claim Form. help NEED A HEALTHCARE FORM

If you have received a Substantiation Letter or Denial Letter, please submit your receipt(s) and/or documentation with the letter you received from EBPA.

DEPENDENT CARE CLAIMS

The IRS guidelines are very specific for the submission of Dependent Care Claims.help NEED A DEPENDENT CARE FORM

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Please note: The uploaded file must be DOC, DOCX, PDF, GIF, JPG, PNG, TIFF or TIF in format. The uploaded file must be less than 10MB in size.

Please note: Renaming a non-supported file tyle to a suported file types will not be accepted. EXAMPLE: myreceipt.png to myreceipt.pdf

Browsers supported: IE, Mozilla Firefox, Google Chrome, Safari, Edge